To explore the effect of autologous fat facial filling combined with small incision facial rhytidectomy in facial rejuvenation surgery. Methods From February 2018 to February 2023, 30 patients who underwent facial rejuvenation treatment in our hospital were selected as the research objects. According to different treatment methods, they were divided into single group and combined group, with 15 patients in each group. The single group was treated with small incision facial rhytidectomy, and the combined group was treated with autologous fat facial filling combined with small incision facial rhytidectomy. The facial quantitative indexes, mandibular margin, nasolabial sulcus morphological scores, facial skin detection indexes, clinical efficacy, cosmetic satisfaction and complications were compared between the two groups. Results After treatment, the distance between bilateral zygomatic points, the distance from the intersection of the pupil vertical line and the nasolabial groove to the pupil point, and the radian of the intersection of the pupil vertical line and the mouth fissure line and the nasal bottom line in the mandibular contour were smaller than those in the single group (P <0.05). After treatment, the scores of mandibular margin morphology and nasolabial groove morphology in the combined group were lower than those in the single group (P <0.05). After treatment, the scores of elasticity and moisture in the combined group were higher than those in the single group, and the scores of spots and oil were lower than those in the single group (P <0.05). The excellent and good rate of treatment in the combined group was 93.33%, which was higher than 80.00% in the single group (P <0.05). The cosmetic satisfaction score of the combined group was higher than that of the single group (P <0.05). There was no significant difference in the incidence of complications between the two groups (P >0.05). Conclusion The facial rejuvenation treatment effect of small incision facial rhytidectomy combined with autologous fat facial filling is better than that of single small incision facial rhytidectomy, which can improve the facial quantitative index and facial skin detection index, optimize the morphology of mandibular margin and nasolabial groove, and will not increase the risk of adverse reactions. Meanwhile, the patient satisfaction is high.